Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 3/2015

01-03-2015 | Review

Colonoscopy: The Current King of the Hill in the USA

Author: Douglas K. Rex

Published in: Digestive Diseases and Sciences | Issue 3/2015

Login to get access

Abstract

Colonoscopy is the dominant colorectal cancer screening strategy in the USA. There are no randomized controlled trials completed of screening colonoscopy, but multiple lines of evidence establish that colonoscopy reduces colorectal cancer incidence in both the proximal and distal colon. Colonoscopy is highly operator dependent, but systematic efforts to measure and improve quality are impacting performance. Colonoscopy holds a substantial advantage over other strategies for detection of serrated lesions, and a recent case–control study suggests that once-only colonoscopy or colonoscopy at 20-year intervals, by a high-level detector, could ensure lifetime protection from colorectal cancer for many patients.
Literature
1.
Neugut AI, Forde KA. Screening colonoscopy: has the time come? Am J Gastroenterol. 1988;83:295–297.PubMed
2.
Rex D, Lehman G, Hawes R, et al. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. Gastroenterology. 1991;100:64–67.PubMed
3.
Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol. 1990;85:969–974.PubMed
4.
Lieberman DA, Smith FW. Screening for colon malignancy with colonoscopy. Am J Gastroenterol. 1991;86:946–951.PubMed
5.
Foutch PG, Mai H, Pardy K, et al. Flexible sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic, average-risk men. Dig Dis Sci. 1991;36:924–928.CrossRefPubMed
6.
Rex D, Sledge G, Harper P, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol. 1993;88:825–831.PubMed
7.
Lieberman DA, Weiss DG, Bond JH, et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–168.CrossRefPubMed
8.
Imperiale T, Wagner D, Lin C, et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–174.CrossRefPubMed
9.
Quintero E, Castells A, Bujanda L, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366:697–706.CrossRefPubMed
10.
Bianco M, Cipolletta L, Rotondano G, Buffoli F. The cooperative flat lesions Italian network (FLIN): prevalence of non-polypoid colorectal neoplasia. A multicentre observational study. Endoscopy. 2010;42:279–285.CrossRefPubMed
11.
Rex DK, Ahnen DJ, Baron JA, et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol. 2012;107:1315–1329.CrossRefPubMedCentralPubMed
12.
Tadepalli US, Feihel D, Miller KM, et al. A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest Endosc. 2011;74:1360–1368.CrossRefPubMed
13.
Hazewinkel Y, Lopez-Ceron M, East JE, et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc. 2013;77:916–924.CrossRefPubMed
14.
Hetzel J, Huang CS, Coukos JA, et al. Variation in the detection of serrated polyps in an average risk colorectal cancer screening cohort. Am J Gastroenterol. 2010;105:2656–2664.CrossRefPubMed
15.
Kahi CJ, Hewett DG, Norton DL, et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol. 2011;9:42–46.CrossRefPubMed
16.
Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–1371.CrossRefPubMed
17.
Mandel JS, Church TR, Bond JH, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343:1603–1607.CrossRefPubMed
18.
Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010;375:1624–1633.CrossRefPubMed
19.
Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012;366:2345–2357.CrossRefPubMedCentralPubMed
20.
Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–1981.CrossRefPubMed
21.
Winawer S, Zauber A, Ho M, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. N Engl J Med. 1993;328:901–906.CrossRefPubMed
22.
Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696.CrossRefPubMedCentralPubMed
23.
Singh H, Nugent Z, Demers AA, et al. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology. 2010;139:1128–1137.CrossRefPubMed
24.
Rabeneck L, Paszat LF, Saskin R. Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy. Clin Gastroenterol Hepatol. 2010;8:275–279.CrossRefPubMed
25.
Rex DK, Rahmani EY, Haseman JH, et al. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology. 1997;112:17–23.CrossRefPubMed
26.
Baxter NN, Warren JL, Barrett MJ, et al. Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol. 2012;30:2664–2669.CrossRefPubMedCentralPubMed
27.
Hassan C, Rex DK, Zullo A, et al. Loss of efficacy and cost-effectiveness when screening colonoscopy is performed by nongastroenterologists. Cancer. 2012;118:4404–4411.CrossRefPubMed
28.
Kahi CJ, Imperiale TF, Juliar BE, et al. Effect of screening colonoscopy on colorectal cancer incidence and mortality. Clin Gastroenterol Hepatol. 2009;7:770–775.CrossRefPubMed
29.
Brenner H, Chang-Claude J, Seiler CM, et al. Protection from colorectal cancer after colonoscopy: a population-based, case–control study. Ann Intern Med. 2011;154:22–30.CrossRefPubMed
30.
Doubeni CA, Weinmann S, Adams K, et al. Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case–control study. Ann Intern Med. 2013;158:312–320.CrossRefPubMedCentralPubMed
31.
Brenner H, Chang-Claude J, Jansen L, et al. Reduced risk of colorectal cancer up to 10 years after screening, surveillance, or diagnostic colonoscopy. Gastroenterology. 2014;146:709–717.CrossRefPubMed
32.
Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1–8.CrossRefPubMed
33.
Mulder SA, van Soest EM, Dieleman JP, et al. Exposure to colorectal examinations before a colorectal cancer diagnosis: a case–control study. Eur J Gastroenterol Hepatol. 2010;22:437–443.CrossRefPubMed
34.
Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013;369:1095–1105.CrossRefPubMed
35.
Barclay RL, Vicari JJ, Doughty AS, et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–2541.CrossRefPubMed
36.
Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007;102:856–861.CrossRefPubMed
37.
Imperiale TF, Glowinski EA, Juliar BE, et al. Variation in polyp detection rates at screening colonoscopy. Gastrointest Endosc. 2009;69:1288–1295.CrossRefPubMed
38.
Shaukat A, Oancea C, Bond JH, et al. Variation in detection of adenomas and polyps by colonoscopy and change over time with a performance improvement program. Clin Gastroenterol Hepatol. 2009;7:1335–1340.CrossRefPubMed
39.
Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–1803.CrossRefPubMed
40.
41.
Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573.CrossRefPubMedCentralPubMed
42.
Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64:104–117.CrossRefPubMed
43.
Zubarik R, Ganguly E, Benway D, et al. Procedure-related abdominal discomfort in patients undergoing colorectal cancer screening: a comparison of colonoscopy and flexible sigmoidoscopy. Am J Gastroenterol. 2002;97:3056–3061.CrossRefPubMed
44.
Pickhardt PJ, Choi JR, Hwang I, et al. Nonadenomatous polyps at CT colonography: prevalence, size distribution, and detection rates. Radiology. 2004;232:784–790.CrossRefPubMed
45.
Zalis ME, Blake MA, Cai W, et al. Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults: a prospective evaluation. Ann Intern Med. 2012;156:692–702.CrossRefPubMed
46.
Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370:1287–1297.CrossRefPubMed
47.
Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595.CrossRefPubMed
48.
Selby JV, Friedman GD, Quesenberry CP Jr, et al. A case–control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–657.CrossRefPubMed
49.
Newcomb PA, Norfleet RG, Storer BE, et al. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992;84:1572–1575.CrossRefPubMed
50.
Brenner H, Chang-Claude J, Seiler CM, et al. Long-term risk of colorectal cancer after negative colonoscopy. J Clin Oncol. 2011;29:3761–3767.CrossRefPubMed
51.
Nicholson FB, Korman MG. Acceptance of flexible sigmoidoscopy and colonoscopy for screening and surveillance in colorectal cancer prevention. J Med Screen. 2005;12:89–95.CrossRefPubMed
52.
53.
54.
Yabroff KR, Mariotto AB, Feuer E, et al. Projections of the costs associated with colorectal cancer care in the United States, 2000–2020. Health Econ. 2008;17:947–959.CrossRefPubMed
55.
Barclay RL, Vicari JJ, Greenlaw RL. Effect of a time-dependent colonoscopic withdrawal protocol on adenoma detection during screening colonoscopy. Clin Gastroenterol Hepatol. 2008;6:1091–1098.CrossRefPubMed
56.
Coe SG, Crook JE, Diehl NN, et al. An endoscopic quality improvement program improves detection of colorectal adenomas. Am J Gastroenterol. 2013;108:219–226.CrossRefPubMed
57.
Buchner AM, Shahid MW, Heckman MG, et al. High-definition colonoscopy detects colorectal polyps at a higher rate than standard white-light colonoscopy. Clin Gastroenterol Hepatol. 2010;8:364–370.CrossRefPubMed
58.
Gurudu SR, Ramirez FC, Harrison ME, et al. Increased adenoma detection rate with system-wide implementation of a split-dose preparation for colonoscopy. Gastrointest Endosc. 2012;76:603–608.CrossRefPubMed
59.
Pohl J, Lotterer E, Balzer C, et al. Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial. Gut. 2009;58:73–78.CrossRefPubMed
60.
Adler A, Pohl H, Papanikolaou IS, et al. A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect? Gut. 2008;57:59–64.CrossRefPubMed
61.
Rex DK, Bond JH, Winawer S, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2002;97:1296–1308.CrossRefPubMed
62.
Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2006;63:S16–S28.CrossRefPubMed
63.
Ko CW, Dominitz JA, Green P, et al. Specialty differences in polyp detection, removal, and biopsy during colonoscopy. Am J Med. 2010;123:528–535.CrossRefPubMed
64.
Goodwin JS, Singh A, Reddy N, et al. Overuse of screening colonoscopy in the Medicare population. Arch Intern Med. 2011;171:1335–1343.CrossRefPubMed
65.
Hewett DG, Rex DK. Improving colonoscopy quality through health-care payment reform. Am J Gastroenterol. 2010;105:1925–1933.CrossRefPubMed
66.
Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–857.CrossRefPubMed
67.
Laiyemo AO, Murphy G, Albert PS, et al. Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med. 2008;148:419–426.CrossRefPubMed
68.
Vemulapalli KC, Rex DK. Risk of advanced lesions at first follow-up colonoscopy in high-risk groups as defined by the United Kingdom post-polypectomy surveillance guideline: data from a single U.S. center. Gastrointest Endosc. 2014. doi:10.​1016/​j.​gie.​2014.​02.​1029.
Metadata
Title
Colonoscopy: The Current King of the Hill in the USA
Author
Douglas K. Rex
Publication date
01-03-2015
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 3/2015
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-014-3448-0

Other articles of this Issue 3/2015

Digestive Diseases and Sciences 3/2015 Go to the issue

Review

Colorectal Cancer Screening Quality, Cost and Practice in an Era of Healthcare Transformation

Review

Colon PillCam: Why Not Just Take a Pill?

Review

Blood-Based Tests for Colorectal Cancer Screening: Do They Threaten the Survival of the FIT Test?

Editorial

CRC Screening, Past, Present, and Future: A Tribute to Emmet Keeffe

Review

CT Colonography for Population Screening: Ready for Prime Time?

Review

Practical Opportunities to Improve Early Detection and Prevention of Colorectal Cancer (CRC) in Members of High-Risk Families
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits